In our last post we brought up the issues with diagnosing dyslexia. Although it is has an underlying biological mechanism, there is not one standard way to diagnose it, and imaging cannot be used to diagnose it either. This was our big problem and the question was how can we improve diagnosis incorporating biology, such as imaging?

Feedback and Our Revised BIG question:

Most people agreed that our question is moonshot material. Our peers enjoyed the fact that we focused on diagnosis. They think looking into this is a good idea, since there is not enough research done on it. They stated that a biological approach (ie. brain imaging) is both interesting and important. A lot of students were surprised that a solution using imaging/biomarkers has not been found yet. Our peers also supported our emphasis on cost problems, agreeing that it is a big issue. Some peers can relate with the content, and this made us happy, since it shows we are addressing something very relevant to those around us. There were not many criticisms, just suggestions, so we believe we are on the right track with our diagnosis question. One student suggested looking into the Gabrieli Lab at MIT that has been looking into neural markers. Another suggested looking into biological markers in adults that were already diagnosed because their brains are fully developed. One student suggested looking into psychological tests, since finding biomarkers may be expensive. Another student, however, thought we should think a little bigger and look at dyslexia from a global perspective, such as places that don’t use the alphabet.

From all the feedback we received, we believe we are making good progress. We will definitely consider our peers’ suggestions going forward. However, we decided to turn away from imaging in our research for reasons you can read below. It sounds crazy, but there were too many issues including the inaccuracies and difficulties using imaging to diagnose children, and imaging costs to make this a reasonable solution. Our revised question is: how can we more effectively diagnose dyslexia? It is not that different from our original plan, just more general. Since the majority of the feedback was positive, with all but one approving our moonshot, we decided that our question of diagnosis was a great one; we just made a few tweaks. The new biological approach we are considering is not imaging. It is genetics. The other approach we are considering is more cognitive in nature: standardized testing. The feedback is still helpful in our new direction. We are going to look into biological markers in those with dyslexia, including the lab mentioned, and into neuropsychological testing, considering age and cost as we do. We will also see what other countries are doing to address dyslexia to have a more global perspective. We believe that looking at dyslexia from those who don’t have an alphabet would complicate the research and, thus, we will look at those with a language that has an alphabet. Our thought process of refining our question and changing our direction is below.

OUR 8 SOLUTIONS AND WHY GENETICS AND STANDARDIZED TESTING ARE THE WINNERS!

Standardized Test

-Moving on to Rapid Evaluation Stage 2

2. Behavioral Examination

-This idea has problems because of the way dyslexia presents itself. Not every child with dyslexia has aggression or antisocial tendencies. Also not every kid that has aggression or antisocial tendencies has dyslexia so the test would not be selective enough and may be a false indicator.

3. Adult Imaging Pre-Mortem

-Every person’s brain is different and dyslexia presents itself in different ways in every person. So while using an overlay of an adult brain with confirmed dyslexia seems the most practical, it would still require additional tests to see if this is actually how dyslexia is presented in the child. Also, we are looking more into early detection so looking at the differences in adult and child brains would pose a problem. Also, the cost for this is another problem.

4. Adult Imaging Post-Mortem

-This would allow us to see the structural differences in a dyslexic and “normal” brain but applying that to a live child’s brain would be difficult. This is more of a research approach than a diagnostic strategy. And again cost is a problem.

5. Child Imaging

-Imaging is very expensive and would require multiple stages because of the uncertainty behind where dyslexia lies in the brain. We want to look into a more practical and valid way of looking for dyslexia.

6. Light Activation of Language Centers

-This poses ethical questions because of how we would look at activating the child’s brain. This is actually a common research technique in mice but we were not sure that is could be as applicable to humans and especially children.

7. Refined Neuropsychological Test with Gold Standard

-This requires a more subjective approach to dyslexia with trained individuals marking performance. Also, it doesn't really hit on the biological side. While a valid approach, we saw this idea as expensive and not as easily implementable in public.

8. Genetic Factors

-Moving on to Rapid Evaluation Stage 2

Moving Forward:

Standardized testing, our first idea moving forward from this stage, will act as a filter across the board to help screen students across the country for flags that may/may not lead to dyslexia. Our idea is having a standardized test with reading and comprehension tasks, as well as other cognitive tasks. We have to decide upon what type of tasks in the future. The point of this testing is that it will narrow down who’s at risk and who isn’t while allowing us to be more effective in detecting dyslexia early on. At the moment, standardized testing is different in every state; private schools most likely do not administer standardized tests, and we would have to determine how to bring a comprehensive screening test to thousands of students across the country. Of course, it is not a perfect solution, but our goal is to improve diagnosis. Further, it shouldn’t be difficult to implement this type of testing in schools, having teachers or nurses administer it since they do so with plenty of other exams.

Genetic testing, our more biological solution, would bring a great solution to our problem. Dyslexia is inherited in some cases and certain genes have been found in those predisposed to having dyslexia. Instead of imaging, we could trace the genetic markers for dyslexia and be able to use them effectively for early diagnosis. Our problem with this is families being limited financially for genetic testing; moreover, the scale of research has been very limited thus far. We thought this is a better solution than imaging, however, because it is more concrete. Some genes have already been targeted and screening can be done on those genes. Imaging is prone to more inaccuracies and heterogeneity.

We plan to pursue both of these ideas until a concrete path is laid out for one. Both ideas have pros and cons, it’s a matter of what’s realistic and effective that will lead to our decision.